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Colorectal cancer is the third-most-common cancer globally and is associated with a five-year overall survival of 65.1%. Current treatment for metastatic colorectal cancer is dominated by chemotherapy regimens in combination with angiogenesis inhibitors and EGFR inhibitors. Several areas of high unmet need—notably, RAS-mutant patient populations—offer significant commercial opportunity for innovative agents. Although sales of immune checkpoint inhibitors and emerging BRAF/MEK inhibitor combinations will increase over the 2017-2027 forecast period, generic and biosimilar competition will also have a major impact on therapy sales. This report provides insight on how treatment options for colorectal cancer are likely to change over the 2017-2027 forecast period. It also analyzes the current and future earnings potential of drugs already in the market and those expected to be approved for colorectal cancer.

Questions answered:

We forecast that sales of colorectal cancer therapies will decline over the 2017-2027 study period. What will be the major constraints on therapy sales? What are the key drivers of growth over this period? What are the drug development activities of note? What challenges and opportunities remain?

Two BRAF/MEK inhibitors combinations—Mektovi/Braftovi/Erbitux and Zelboraf/Erbitux/irinotecan—have shown promising efficacy in BRAF-mutant colorectal cancer patients. What is thought-leader opinion of these agents and of this drug class? For which patient populations will these agents be positioned? Will these agents receive approval in the markets under study? How will use of these agents affect prescribing of other agents for colorectal cancer?

In 2017, the FDA approved Keytruda (Merck) and Opdivo (Bristol-Myers Squibb) for second- and later-line treatment of MSI-H/dMMR colorectal cancer that is refractory to a fluoropyrimidine, irinotecan, and oxaliplatin. In 2018, Opdivo plus low-dose Yervoy received FDA approval in the same setting. How do key opinion leaders perceive these therapies? Will these therapies receive label expansions across the G7? Which other immune checkpoint inhibitors are being developed and in which patient populations?

Retrospective analyses of clinical trials with Avastin and EGFR inhibitors have shown that the side on which the tumor is located could be a prognostic factor for response to these agents. How do key opinion leaders view these data? Will “sidedness” have an impact on the treatment of metastatic colorectal cancer over the forecast period?

Jorrit Schäfer, , is a business insights analyst at Decision Resources Group. Prior to joining DRG, Dr. Schäfer worked as a postdoctoral research associate at Imperial College London, where he studied the impact of antibiotic stress on RNA repair in bacteria. Dr. Schäfer holds a in molecular medicine and a in molecular cell biology from Imperial College London.

Alison Isherwood, , joined Decision Resources Group in 2008, as an Epidemiologist. Alison holds a in Medical Microbiology, Masters by Research in the Life Sciences and a in Epidemiology all from the University of Edinburgh. Prior to joining Decision Resources Inc., she was working on her in Molecular Virology, specializing on the severe acute respiratory syndrome (SARS) coronavirus, at the University of Reading. In her role at Decision Resources Group, Alison is currently an Epidemiology team lead as well as project managing custom epidemiology work in multiple therapy areas. Alison’s area of specialization at DRG is cancer, particularly breast cancer.